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General NPI Number Information
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NPI Number | 1184676777
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Entity Type | Individual
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Provider Name | VICKIE A. WOODS-MODELAND PNP
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Gender | Female
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Dates
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Enumeration Date | 05/16/2006
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Last Update Date | 08/29/2023
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Provider Practice Location Address
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Address Line | 701 E DAVIS ST STE. A
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City | CONROE
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State | TX
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Zip | 77301-3018
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Country | US
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Telephone | 936-525-2800
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Fax | 936-539-4668
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Provider Business Mailing Address
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Address Line | 301 UNIVERSITY BLVD
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City | GALVESTON
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State | TX
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Zip | 77555-5302
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Country | US
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Telephone | 409-772-2222
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | 239394
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License Number State | TX
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